Professional Fee Coding Auditor

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Professional Fee Coding Auditor based in the United States. This fully remote role supports coding quality and compliance across medical facilities within a large regional healthcare network. You will independently audit professional-fee coding for documentation accuracy, regulatory compliance, and reimbursement impact. The position focuses on provider services, diagnoses, procedures, evaluation and management coding, modifiers, and professional components. You will identify discrepancies, document findings, assess financial and compliance risks, and recommend corrective actions. The role also includes preparing reports, participating in calibration activities, and delivering facility-specific coding education. You will collaborate with health information management leadership and facility stakeholders while maintaining strict confidentiality. The assignment requires a high level of coding expertise, attention to detail, and consistent audit accuracy in a regulated environment. Accountabilities - Independently audit inpatient and outpatient professional-fee coding for accuracy, documentation support, compliance, and reimbursement impact. - Evaluate ICD-10-CM, CPT, HCPCS Level II, evaluation and management, professional-component, modifier, and bundling assignments. - Verify provider information, scope of practice, billability, and documentation supporting reported professional services. - Review diagnoses and procedures documented in electronic health records and approved audit tools according to established sampling requirements. - Identify incorrect, missing, unbundled, upcoded, downcoded, unsupported, or otherwise noncompliant codes and modifiers.

- Document each audit finding with appropriate supporting authority, financial impact, risk assessment, and recommended corrective action. - Maintain a minimum audit accuracy of 95% and participate in calibration activities to promote consistency among reviewers. - Contribute to audit work plans, data collection tools, facility reports, consolidated reporting, and required progress updates. - Review preliminary findings with health information management leadership, the Contracting Officer's Representative, management, and designated facility personnel. - Prepare or support final reports covering coding accuracy, documentation deficiencies, financial impact, process improvement opportunities, and educational needs. - Develop and deliver facility-specific coding education and support exit conferences when required. - Protect sensitive healthcare information and follow all privacy, information-security, encryption, and remote-work requirements. - Maintain required credentials and complete all assigned audits, reports, training, and access requirements within established deadlines. Requirements - Active RHIA, RHIT, CCS, CCS-P, CPC, or CPC-H credential from an accepted professional organization. - At least two years of professional coding experience in the applicable coding area. - At least three years of consultant experience reviewing records in large tertiary-care hospitals and outpatient organizations serving primary care and subspecialty populations. - At least three years of education and training experience, including the ability to present audit findings and deliver facility-specific coding education. - Strong knowledge of ICD-10-CM, CPT, HCPCS Level II, evaluation and management services, modifiers, professional components, bundling, reimbursement, documentation, and coding compliance requirements. - Demonstrated ability to evaluate provider documentation and determine whether reported professional services and codes are adequately supported.